Staphylococcus aureus decolonization

• Staphylococcus aureus is commonly found in the nares and on the skin of healthy people
• Asymptomatic colonization is associated with a higher rate of invasive infection

Project CLEAR

• Probably has the best evidence, with an RCT1
• Decolonization happens for 5 days, twice monthly, for 6 months
  • 4% rinse-off chlorhexidine for daily bathing or showering
  • 0.12% chlorhexidine mouthwash twice daily
  • 2% nasal mupirocin twice daily
• NNT of about 30 to prevent one infection or one hospitalization

Dutch Method

• Also has some evidence, with an observational study2
• Separates patients into uncomplicated (essentially entirely asymptomatic carriage in a low-risk patient) and complicated
• In the above report, the only reported outcome was decolonization
  • 63% after 1 cycle, and 80% after up to 5 cycles of treatment
  • 97% remained decolonized at 3 month follow-up

Uncomplicated carriage

• Topical treatment (5 days)
  • Mupirocin 2% to nares q8h
  • Chlorhexidine or povidone iodide soap applied once daily
• Hygienic measures
  • Clean underwear, clothing, washcloths and towels daily
  • Change bedsheets every other day during treatment

Complicated carriage

• As above, plus oral antibiotics
• Trimethoprim 200 mg PO BID or doxycycline 200 mg PO once daily, plus rifampin 600 mg twice a day for 1 week
• Alternative: clindamycin 600 mg PO TID or clarithromycin 500 mg PO BID or ciprofloxacin 750 mg PO BID or fusidic acid 500 mg PO TID, plus fusidic acid 500 mg PO TID